OBJECTIVE:
To describe the representation of nursing care for nurses and for individuals
undergoing hemodialysis.METHODS: This qualitative study was conducted in the Minas Gerais Nephrology
Center in Belo Horizonte with 6 associate degree nurses and 6 individuals undergoing
hemodialysis. Data were collected through focused interviews and analyzed through
content analysis of group discussions.RESULTS: Nursing care among the nurses was the establishment of therapeutic
relationships and trust, and technical professional care. For the individuals
undergoing hemodialysis, receiving nursing care was the establishment of interpersonal
relationships, adherence to hemodialysis treatments, and prolonging their life.CONCLUSION: The representation of nursing care goes beyond technical
professional care to include therapeutic and interpersonal relationships.

The chronic renal
failure, due to pathophysiological, psychological and socioeconomic, represents
a public health problem(¹). It is characterized by
the loss of renal function irreversible demanding substitute treatment as only
condition of life maintenance(²). Clients subject
to renal dialysis, in general, develop depression, non-cooperative behave, sexual
dysfunction, difficulties related to occupation and rehabilitation. By this
way the disease interfere in life quality compromising physical and social well-being
of this clients(3).

The hemodialysis
is the most used dialysis method to remove toxic nitrogen substances from the
blood and water excess. It requires intensive care due to the possibility of
clinic intercurrences(4). By this way it is important to think about
the nursing care with chronic patients, particularly as regards to the quality
of the assistance, resolvability of the service/treatment and education in health(²).

Taking care involves
interactive actions that must be built on the ethical dimension between the
caregiver and the client(5). Particularly hemodialysis requires specialized
nursing care, but it is not reduced to technical care. Therefore It is evident
the need of nursing professionals to be capable and aware of its importance
to the maintenance of life quality of the clients(²).
From this preamble this research had as objective to identify the representation
of taking care in the hemodialysis for the nursing team and for the client in
hemodialysis treatment.

METHODS

We have done a
qualitative research with professionals from the nursing team and clients of
the nephrological center of Minas Gerais (CENEMGE), located in Belo Horizonte.
CENENGE is specialized in substitutive kidney therapy treatment in the genre
of hemodialysis and peritoneal dialysis. The sample was constituted by six nursing
technicians who worked for more than two years and twelve clients who were in
hemodialysis treatment for more the two years.

For the data collection
it was used a semi-structure interview with a guiding question: "What is to
take care?" for the professionals; and "What is to be cared?" for the clients.
Respecting the Resolution nº 196/96 from the National Health Council, we had
approved of the research project in the Research Ethics Committee of PUC Minas,
the authorization of the director of CENEMGE and the consent of the interviewed
signing the Consent Form. The data was analyzed by the methodological reference
of the Collective Subject Speech that uses methodological pictures to arrange
and chart the data(6). The speech produced from the interview with
the nursing technicians and clients were identified with names of flowers and
birds, respectively.

RESULTS

We found as to
take care to the professionals from the nursing team representations of therapy
relationship, trust relationship and technical relationship:

Taking care as
therapy relationship: "Taking care is to respect the different type of the
clients. Giving attention respect and tenderness. Being aware, sitting, saying
a word, to the needs and the emotional health of the client".

Taking care as
trust relationship: "Taking care is to be partner beyond anything, from the
moment he trusts he knows somebody is taking care of him. The person at the
hemodialysis always fears that something happens to the machine and doesn't
sleep, but when they trust they calm down and sleep".

- Taking care as
technical relationship: "Taking care is to do everything to be a quiet dialysis,
like the medicines on time, to weight, to check the temperature, aseptic punction,
to clean the material and test it".

We found interpersonal
relationship, joining the treatment and extension of life as being cared to
the clients.

- Being cared as
joining the treatment: "Being well cared is to recover better and pass well
in the hemodialysis, it is having control with the eating, personal hygiene
and from the arm and medication. It is eating properly according to the diet,
taking medicines on time, follow the schedule and aware with the weight".

- Being cared as
extension of life: "It is having my life extended, because making hemodialysis
is living".

DISCUSSION

The idea of taking
care as therapy relationship means assist to the needs with sensitivity and
promptness through actions that promote the well-being, this effect being cared
relates physical and emotional integrity(7). For this the nursing
must develop observation skills and dialogues, order to situate the problems
experienced by the client inside their cultural and social context(8).

The concern about
other's well being results in trustful feelings. Taking care implies in a trustful
relationship because the client gives its self that is fragile, on the caregiver
hands(9). And the caregiver through an attentive presence enables
to the client also to trust in the environment/treatment. In this study we found
that taking care also refers to establish trust relationship. The care fitted
to the client needs demand from the professional capability to understand the
other's need(7). The recognition of the care needs, added to technical-scientific
actions referred to physical, technical and emotional care constitute in requirements
to the effectiveness of the process of taking care(9).

In the exercise
of nursing the technique content can be resized, because taking care can also
allow the comfort of the client that is emotional fragile, softening the client
anguish and fear, through the approach from the caregiver during the accomplishment
of an technique(7). For this, another meaning to the taking care
found in nursing was the representation of technical relation.

We found the idea
of being cared, for the patients in hemodialysis treatment, as to establish
interpersonal relationship. Assuming that interpersonal relationship includes
humanized care we understand the importance for the professionals to provide
favorable conditions to the humanization of the care(9).

The patient with
chronic renal failure is submitted to changes in its daily activities, like
diets, control of drinking liquids, medication use, threat to the self-image,
that cause stress and conflict, stepping in the joining of the patient to the
therapy. The client in hemodialysis treatment depends on the technology and
capable professionals, for this the machine represents the maintenance of the
homeostasis physical(10). Corroborating this ideas, we found the
care as including to the treatment and extension of life.

CONCLUSION

We identified that
taking care for professionals from the nursing team transcends the techniques
content, traversing through the taking care as establish of therapy and trust
relationship. For the clients in hemodialysis treatment, to be cared meant to
establish an interpersonal relationship, joining the treatment and to have its
life extended, being clear the importance of each function in the triad, client-professional-machine
to the success of the treatment.

Even with the complexity
and specificity that involves the process of hemodialysis and demand specify
technical and scientific knowledge, permeated by constant technological influences,
the nursing team showed assistance that goes beyond than making (execute procedures
and techniques), operating in the perspective of humanized care, aware with
the "being cared".